One of the most enduring issues in hospital operations is the control of patient flows through the system. Too many patients in our experience overstay in hospital beyond that which is necessary to complete their acute treatment. Typically, 30 to 40 % of patients in hospital do not actually need to be there, with profound consequences not only for patients but also for hard-pressed NHS budgets.
The issue of delayed discharge is still a very real issue for patients but particularly so for elderly, frail patients displaying multiple morbidities, who ‘decompensate’ very quickly whilst in hospital, losing functionality, skills and confidence as well as risking further illness through hospital acquired infections. Thus, the longer such patients are in hospital the harder it is to rehabilitate them back in the community.
It is important to be certain that such patients need to be admitted in the first place; that their hospital stay is managed efficiently to allow earlies possible discharge once their acute episode is over; and that discharge processes are planned early and effectively with the right patient moving to the most appropriate setting for their onward care as soon as possible.
Working with clients we have tackled these issues by improving processes so they work in parallel rather than in series and with careful management. We have conducted audits and reviews that map patient journeys ascribed to different pathways through the system and quantified the nature, extent and cost of delays.
We have also designed and recommended models of ‘discharge to assess’ for different patient cohorts and their financial implications for the health and social care economy given the need for solutions that are at worst ‘cost neutral’ to the system.
